Evalina Burger, MB ChB, MMed, an expert spine surgeon and accomplished administrative leader, has been named chair of the Department of Orthopedics at the University of Colorado School of Medicine, effective Nov. 1, 2018.
Burger, who joined the CU School of Medicine faculty in 2006, is a successful and highly productive surgeon who has been recognized frequently by her peers as one of the best physicians in the country. In addition to her clinical work, Burger has been an active investigator and educator working to find new metal-alloy compositions to improve orthopedic implants.
She has written more than 60 peer-reviewed publications and several book chapters. She also serves on editorial boards of scholarly journals and has co-edited two textbooks on spine surgery. She has actively participated in FDA clinical trials for spine implants and has received several grants to support her work.
“Through innovation, infrastructure and inclusion, I see the Department of Orthopedics becoming a leader and an integral part of healthcare delivery on a national level,” Burger said. “With a diverse faculty, I hope to grow the department into a global destination for healthcare excellence.”
Burger was selected after a national search to succeed Robert D’Ambrosia, MD, who joined the CU School of Medicine in 2002 and who has been a catalyst for growth and an inspirational champion of the university’s diversity efforts. When D’Ambrosia joined CU, there were six faculty members in the department and there are now more than 110.
Burger has also been a key administrative leader in the Department of Orthopedics, serving as vice chair of clinical affairs since 2008. In her leadership role, she led efforts in clinical service development and reorganization and strategic business planning. She has also helped improve workflows to enhance quality patient care in a teaching environment.
“Dr. Burger is a talented surgeon and a dedicated colleague,” said John J. Reilly, Jr., MD, dean of the CU School of Medicine. “She articulated an ambitious vision for the department, building upon the foundation established by Dr. D’Ambrosia, and clearly recognizes the importance of all of our missions. She successfully treats patients from all walks of life while efficiently managing the need for high-quality and efficient care in an academic setting. We are fortunate to have her on our faculty and I look forward to working with her in her new role as the chair of a growing department.”
Burger graduated with a medical degree, MB ChB, from the University of the Orange Free State in South Africa in 1984. She also earned a graduate degree, an MMed, from the University of Pretoria in 1993. In 2000, she became the first female orthopedic surgeon from South Africa and only the third woman ever to receive the American-British-Canadian Traveling Fellowship, which is awarded to highly accomplished young surgeons from English-speaking countries.
Prior to joining CU, Burger was an associate professor at Louisiana State University Health Sciences Center in New Orleans from 2001 to 2006. While there, she helped establish the first fully functional orthopedic clinic after Hurricane Katrina.
The Colorado Rapids Youth Soccer Club (CRYSC) is partnering with leading sports medicine specialists at the University of Colorado Department of Orthopedics at the CU School of Medicine and UCHealth to ensure its athletes receive unsurpassed care as well as education about injury prevention.
Acting as liaison between CU, CRYSC and UCHealth is Head Athletic Trainer Julie Graves, MA, ATC, who became the full-time athletic trainer for the Colorado Storm soccer club two years ago. Her role has expanded as the Storm recently merged with CRYSC, creating a super-club of over 10,000 players ages 3 to 18. CU Orthopedics’ title sponsorship is similar to the arrangement with Storm, but “it’s just at a bigger volume,” Graves said. “We’ve had two years of providing top-tier care and it’s going extremely well.”
Teaming with CRYSC and its five regions along the Front Range comes at an ideal time as the Department of Orthopedics is experiencing a high rate of growth. “Adding this to our portfolio positions the department for a high level of exposure across Colorado, and we look forward to strategically growing this relationship with the Colorado Rapids Youth Soccer Club over the next several years,” said David Kaplan, Orthopedics Department finance administrator.
Graves works with three medical directors who volunteer their time to provide care for club members. “We try to get our kids directly into one of those three first and foremost, but if they’re overbooked we find another CU sports medicine specialist to provide care,” Graves said. “This really gets them right where they need to go in an expedited manner.”
Graves has treated a variety of injuries on the field including dislocated kneecaps, labral hip tears and sprained ankles. However, treatment doesn’t stop on the field. Graves further develops the at-home rehab program, recommending exercises and stretches, and follows up on the player’s progress. Graves has also established an athletic training evaluation space inside the CRYSC Central Region headquarters where the members come to have their appointments. Having a dedicated space gives her the ability to see injuries within 24 to 48 hours, as well as provide treatment or taping before practice.
Positioned for injury prevention
The partnership between CRYSC and CU Orthopedics is a special one. Kaplan notes, “Becoming a sponsor uniquely positions us to focus on injury prevention with these young athletes and ultimately care for them at the appropriate location when an injury does occur. The Sports Medicine team across the School of Medicine has the expertise and experience to take care of the Colorado Rapids Youth Soccer Club athletes similar to the way we cover University of Denver athletics, University of Colorado athletics, Denver Nuggets, Colorado Avalanche, Mammoth, Rockies and Denver Broncos.”
For athletes, the presence of an athletic trainer takes away the worry of when an injury occurs and next steps. In the event of a more serious injury, Graves close working relationship with CU Sports Medicine specialists has afforded her the ability to refer athletes and their parents to the most appropriate specialist depending on location, severity, or type of injury. This is the same approach CU Sports Medicine takes with collegiate level teams and the professional teams they support.
Graves frequently hears from grateful parents. “I’ve gotten absolutely wonderful feedback from the athletes and parents,” she said. “They’re so grateful that the club has an athletic trainer and a huge orthopedic partnership that provides quick, effective and professional treatment for their kids.”
The patient breathes harder as his workout intensifies. His metabolic fingerprint – heart rate, oxygen level and other data – streams onto a tablet in the form of a colorized digital bar that shows exactly what his muscles are doing and the fuels he’s burning.
“In the purple zone he’s stressing his anaerobic system, and in the red he’s going to burn muscle mass if he stays up there too long,” says Nicholas Edwards, director of Exercise-Medicine Integration in the Department of Family Medicine, CU School of Medicine. “The blue here represents his prime zone, where he performs best during exercise and creates the most energy, so he’s safely burning the most pound for pound right at this second.”
Edwards is also co-founder and chief scientific officer of METHOD, a CU spinoff company, that is proving to be a health game-changer by connecting exercise to medicine. The system gives thousands of pro athletes and patients access to individualized, real-time metabolic information that, when combined with a prescribed fitness regimen, builds strength and stamina, reduces injury, sheds weight and improves their response to treatment.
‘Medically based fitness plan’
These metabolic data points help tailor regimens to a specific physiology – whether the person be a pro athlete, weekend warrior or couch potato – to provide healthy outcomes across the continuum of care. “It’s literally like a medically based fitness plan,” says Edwards, who three years ago launched METHOD with an eye toward college and pro athletes. Among the first users were elite athletes who were patients in the Ascent Program at the Center for Dependency, Addiction, and Rehabilitation (CeDAR). The METHOD system has expanded to thousands of patients and athletes, including the NHL’s Colorado Avalanche, NFL teams as well as fitness facilities and centers for orthopedics and physical therapy from coast to coast.
Besides being a breakthrough approach – making exercise a prescribed medicine – the METHOD app is a testament to the collaborative innovations regularly occurring on the CU Anschutz Medical Campus. Family Medicine owns a stake in the enterprise, which was assisted in its launch by CU Innovations. “We collaboratively worked on a system that covers the spectrum – orthopedics through physical therapy to human performance,” says Edwards, who has two business partners.
“Previously, there was nothing that quantified what a person in the gym, the rehab center or the weight room is doing metabolically in real-time,” he says. “Anaerobic exercise was a guess. Through METHOD, we’ve been able to identify somebody’s unique metabolic fingerprint to know what’s going on physiologically as they exercise.”
‘It’s been amazing’
Dan, a patient at UCHealth, went through the three stages of the METHOD system – evaluation, prescription for exercise, and monitoring – under Edwards’ supervision. Dan is a high-level crossfit competitor and works as a paramedic, so he understands the value of physiological data such as heart rate and energy thresholds. “Using the METHOD data, Nick built a training program specific to my capabilities that matched my heart rate and everything,” Dan says. “It’s been amazing. I’ve gotten stronger, faster and more physically fit in the last month and a half than I’ve done on my own, just kind of blind training, over the last year.”
‘This system really dials everything in.’– Nicholas Edwards, METHOD chief scientific officer
Meanwhile, people on the other end of the spectrum, the sedentary and obese, often tell Edwards they don’t know how to workout, feel pain when exercising or are simply intimidated. “The great thing about this system is we’re able to give them specific parameters to know exactly where they should exercise, the exact kind of exercise, and when to start and stop, so they change their body in a healthy and safe way,” he says. “This system really dials everything in.”
Because the app loads onto smartphones and synchs with heart rate monitors, it’s able to monitor whether a user is staying in a metabolic zone too long. “The phone will literally buzz and tell them to speed up or slow down their workout,” Edwards says. “The app has built-in coaching mechanisms across the board.”
‘Solidify best practices’
And the app acts as massive data repository that allows clinicians to view real-time data from users around the country. “I can monitor somebody on an exercise prescription in Maine or in Southern California and compare their outcomes to somebody here in Colorado,” says Edwards, who played college football at North Dakota State and is a former mixed martial professional. “Our goal is to solidify best practices over time.”
Improved outcomes mean athletes get back on the ice or field faster, while patients, either those recovering from surgery or just going through physical therapy, return to their normal lives sooner, Edwards says. “The big payoff is that by optimizing patient outcomes we’re lowering the cost of care, because you’re eliminating guesswork and duplication of services.”
Ditching a worn-out formula
For example, METHOD renders obsolete the timeworn 220-minus-your-age formula for determining a person’s maximum heart rate. Edwards gives the example of a 55-year-old couch potato and a former pro hockey player of the same age. “If you do that old formula, they should exercise the exact same way, which is ludicrous,” he says. “We need to find something different that’s happening with that individual every single day, and that’s what we do with METHOD.”
When not directly coaching athletes and patients through exercise regimens, Edwards speaks about the benefits of METHOD and proper training across the U.S. at the NFL Combine, behavioral health and strength and conditioning conferences and other events. He notes that the system is “really starting to catch fire” as more people turn to individualized exercise regimens.
Edwards says METHOD will further elevate CU SOM’s stature as a global leader in innovation, wellness and health care outcomes. “We’re developing a lasting change – to make medicine and exercise collaborate long term.”
Considering that CSI offered 263 training sessions to surgeons from around the world in fiscal 2016 – up 65 percent from 2015 – it’s safe to say that the facility’s innovations and education programs are rapidly improving health care across the globe.
CSI typically offers four to five trainings a week. It’s not unusual for surgical courses on skull base tumors to take place one day, aortic aneurysms the next and hernia repair the next. Partitions are often set up so different trainings – a spinal surgery here, a heart procedure there – can take place simultaneously. Surgical techniques on every quadrant of the body are taught in the facility by world-class experts from the CU School of Medicine (SOM) using state-of-the-art equipment.
‘Our mission is to educate’
“We try to be a one-stop shop for everyone who trains here. We handle logistics on everything from lodging and transportation to the specimen and equipment needs of each training,” said Sarah Massena, CSI executive director. “We just try to make it streamlined and easy for the trainees who come here, so they can go back home and enhance patient safety.
“Our main mission is to educate,” she said, “We want to enhance patient safety in the operating room.”
CSI, which operates 24/7 and is the only surgical training center at an academic institution in this region, moved to a new space inside Bioscience 1 in the Fitzsimons Redevelopment Authority (FRA) in early 2015 and has seen a dramatic increase in trainings since. Last year, 3,400 surgeons attended trainings in the 5,000-square-foot facility.
The high-volume facility, which launched in 2005, was previously located in a 1,700-square-foot space in the anatomy lab on the fifth floor of the Education 1 building.
“One of the major advantages of this facility is that it’s a custom build-out,” said Peter Mouser, CSI lab manager. “These suites were an empty shell, and we worked with our architects and building-design people to have the surgical training suite be built out the way it should be.”
Attractive to medical device industry
A challenge, however, is that the CSI loses the rent discount that came with being physically located on an academic medical campus. Being across the street – the FRA is located on the north side of Montview Boulevard – means that CSI’s rent increased. “We had to move here because, for our needs, it was the only space available,” Massena said. “We’re still right next door to an academic medical campus, so our trainees can drive in, park for free and come straight into our lab.” For physicians already on campus, including residents at the University of Colorado Hospital (UCH), CSI is an easy walk to and from the hospital.
The facility is multidisciplinary, so it has five founding surgical departments in the SOM that help fund its operations. The departments, representing 15 surgical divisions, are Surgery, Orthopedics, Obstetrics and Gynecology, Otolaryngology and Neurology. The many “outside” trainings offered by CSI – 70 percent of the courses are for surgeons from outside the CU Anschutz Medical Campus, compared to 30 percent for residents at the campus – help subsidize the departmental-member trainings.
CSI is attractive to industry representatives seeking to test medical technology. Medtronic, an international medical device company, collaborates with Omid Jazaeri, MD, an associate professor in the Department of Surgery, on its latest stent technology. Da Vinci Surgery regularly brings in its magnified, 3D high-definition vision technology for trainings. The state-of-the-art robotics system allows surgeons to operate with enhanced vision and precision. The system also allows a surgeon at another location, such as on the East Coast, to operate a remote console and perform procedures in CSI’s surgical suite.
Each spring, Samy Youssef, MD, PhD, professor of neurosurgery in the CU SOM, has trained over 60 surgeons from around the globe at a three-day cadaveric dissection-training course in skull base/endoscopic surgical techniques. The invitational course is in high demand and currently filled through the 2020 session.
“The surgeons we have coming from Germany, Japan and elsewhere are impressed when they see this facility,” Youssef said. “For example, it’s very convenient to have the lecture room next door to the surgical room where the senior residents get hands-on practice.”
In addition, CU’s Department of Neurosurgery offers a Skull Base Surgery year-long fellowship/resident program that uses the CSI Microsurgery Laboratory to give young neurosurgeons exposure to complex cranial cases and minimally invasive skull base approaches.
Besides the cadavers on the operating tables and the surgeons in scrubs surrounding them, the striking elements of CSI are the innovative pieces of equipment, flat-screen monitors all around, and the booms that house the equipment. Less obvious are ceiling cameras that can zoom in on proctor stations and livestream procedures across the globe. Procedures are also regularly recorded.
Robust AV technology
Trainees can watch a live feed of a surgery taking place at UCH and simultaneously practice the techniques on specimens at CSI. “The audio-visual (AV) technology is very robust in this facility,” Mouser said. “It really provides for an enhanced educational experience for our surgical trainees.”
The facility is so busy that it is already bursting at the seams to store its surgical equipment. Staffing is another area that had to be increased to deal with demand. CSI recently hired two lab support technicians to help stagger the hours of the small staff – the facility now has five employees, including Medical Director Thomas Robinson, MD – around the late-day, early-morning and weekend training sessions that best suit surgeons’ busy schedules.
The staff at CSI constantly has dialogues with surgeons about the latest techniques and equipment on which they’d like to have training. “Also,” Massena said, “we engage in a lot of continuing medical education for surgeons to learn the latest surgical techniques.
“What I always say is, ‘Wouldn’t you rather that your surgeon practices techniques in a lab than on your mother, father, brother or sister in the OR?’” she said.